How patient movement can interfere with femto laser-assisted cataract surgery

Suction was lost during lens segmentation. The segmentation pattern that was intended for the lens nucleus unintentionally treated the cornea. (Video courtesy of Sonia Yoo, MD)

Misplaced laser beam delivery is not a common occurrence. Dr. Yoo said she found just one similar event in literature, submitted by one of the session discussants, Samuel Masket, MD, Founding Partner of Advanced Vision Care and Clinical Professor of Ophthalmology at the Jules Stein Institute, David Geffen School of Medicine, University of California, Los Angeles. The common contributing factor to both events was patient movement. Dr. Yoo’s patient was moving so much she needed three attempts to dock and establish suction.

Once suction was established on the third try, the femto platform safety mechanisms should have detected the subsequent loss of suction and blocked the laser pulse. Instead, it appears that the conjunctiva occluded the suction holes, which prevented the platform from detecting the loss of suction and allowing the laser to fire after the eye had moved and delivering the segmentation pattern to the cornea.

Fortunately, the patient had a healthy Bell’s response and the eye had rolled up and out as she began to blink. The laser treatment was limited to the inferior third of the cornea and there was no damage to the central cornea.

“I don’t know if applying the segmentation pattern to the central cornea would have made a difference in post-op vision, but I was relieved we didn’t have to find out,” Dr. Yoo said. “More than a year out, I can still see that grid pattern on her cornea, but there have been no visual sequelae. Dr. Masket said he had a very similar case except that the grid pattern on his patient’s cornea faded over time.”

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